Choledochal cysts are cystic dilation of extrahepatic duct, intrahepatic duct, or both that may result in significant morbidity and mortality, unless identified early and managed appropriately. The incidence is common in Asian population compared with western counterpart with more than two third of the cases in Asia being reported from Japan. The traditional anatomic classification system is under debate with more focus on etiopathogenesis and other aspects of choledochal cysts. Even though categorized under the same roof, choledochal cysts vary with respect to their natural course, complications, and management. In this review, with the available literature on choledochal cysts, we discuss different views about the etiopathogenesis along with the natural course, complications, diagnosis, and surgical approach for choledochal cysts, which also explains why the traditional classification is questioned by some authors.

An uncomplicated gall stone disease can be treated by low pressure laparoscopic cholecystectomy with reasonable safety by an experienced surgeon. Though surgeons experience more difficulty in dissection during low pressure pneumoperitoneum, it is significantly advantageous in terms of postoperative pain, use of analgesics, preservation of pulmonary function, and hospital stay.

Background: Corrosive injury resulting in gastric outlet obstruction (GOO) is fairly uncommon in world literature. We aim to study the socio-demographic variables of corrosive acid ingestion patients presenting as symptomatic GOO, along with the surgical procedure performed in these patients, post-operative complications and long term follow up data.Methods: We included all patients with clinical features of gastric outlet obstruction following acid ingestion, who were operated in our department between January 2006 and April 2017. We collected patient’s demographic data, parameters during surgery, body weight and nutritional status pre- and post-operatively, which were all derived from case records and outpatient records. Follow up data of the patient were collected when possible.Results: During the study period, 81 patients were enrolled in the study; 42 males, average age 35.76±3.53 years, 82% had suicidal intent of ingestion and 18% accidental; average follow-up period was 80.5 months. After an average period of 6 months, 94% underwent loop gastrojejunostomy. Approximately, 22% suffered complications like surgical site infections, postoperative fever, pulmonary infections and postoperative vomiting. Average follow up of 6.7 years done in 68 patients who underwent only bypass without resection, none of the patients developed any malignancy of upper gastrointestinal tract.Conclusions: Staged treatment for GOO patients was seen to be associated with good clinical outcomes and few complications. Bypass of cicatrised stomach without resection gives acceptable results.

Background/Aim:Hypersplenism due to splenic congestion is observed in portal hypertensive patients. This study was done to know the change in platelets count following early ligation of splenic artery during splenectomy in patients with thrombocytopenia due to portal hypertension with a hypothesis that splenic decongestion results in increased platelets count; thereby platelet transfusion can be avoided.Materials and Methods:Patients with platelets count <100,000 per mm3 due to portal hypertension were involved and we followed a protocol of ligating splenic artery first, followed by 30 minutes waiting period for splenic decongestion. Blood sample was collected at 5 and 30 minutes for the estimation of platelets count.Results:Significant rise in platelets was observed after 5 and 30 minutes of early ligation of splenic artery with mean rise being 23735 ± 15417 and 35085 ± 20458 per mm3, respectively. The rise in platelets at 30 minutes was significant when compared with 5 minutes rise with mean platelets count being 91661 and 103070 per mm3 at 5 and 30 minutes, respectively. The platelets rise was equal to 4 and 6 units of platelets concentrates, respectively.Conclusion:Early ligation of splenic artery during splenectomy for portal hypertension results in significant rise in platelets after 5 and 30 minutes. This method conserves platelets and avoids platelets transfusion and its complications.

Electrical burns can be devastating and result in dreaded outcomes. Electrical burn is a common problem in our society and needs special attention because of its various modes of presentations, the numbers of organ systems involved, and the mortality associated in spite of the small percent of burns. The authors present a case of electrical burns with a posterolateral chest wall defect associated with blunt abdominal trauma that was successfully managed by debridement and pedicled omental flap over a synthetic prolene mesh.